Correspondence  |   March 2019
Does Intravenous versus Inhalational Induction of Anesthesia Only Decrease Perioperative Respiratory Events during the Induction Period?
Author Notes
  • University of Colorado School of Medicine, Aurora, Colorado (T.T.N.). thanh.nguyen4@childrenscolorado.org
  • (Accepted for publication November 19, 2018.)
    (Accepted for publication November 19, 2018.)×
Article Information
Correspondence
Correspondence   |   March 2019
Does Intravenous versus Inhalational Induction of Anesthesia Only Decrease Perioperative Respiratory Events during the Induction Period?
Anesthesiology 3 2019, Vol.130, 510. doi:10.1097/ALN.0000000000002573
Anesthesiology 3 2019, Vol.130, 510. doi:10.1097/ALN.0000000000002573
We read with interest the study by Ramgolam et al.,1  in which they demonstrated that IV induction in children 8 yr and under was associated with fewer perioperative airway complications compared with inhalational induction with sevoflurane and nitrous oxide. We commend the authors for setting up a randomized trial to improve the delivery of anesthetic care for children with higher risk of airway complications. Upon analysis of the complications data, it seems that the majority of the complications occurred during the induction process for the inhalational group (47 events out of a total of 64), while the IV induction group had fewer complications during the induction period. In contrast, the IV induction group had relatively more respiratory complications during the rest of the intraoperative and postoperative periods (26 events out of a total of 39). However, given the manner in which the data are presented (any [1 or more] respiratory event), it is impossible to truly decipher the incidence of any postinduction perioperative respiratory events from the manuscript. When minimized (difference between any unadjusted perioperative and any unadjusted induction respiratory events), it appears that there was no statistical difference in postinduction events between the two groups (23/149 [15.4%] vs. 17/149 [11.4%], relative risk [RR]: 0.7, 95% CI: 0.4 to 1.3, P = 0.4). This calculation is limited, however, by the fact that each patient may have had more than one event over the perioperative course, and the study did not specifically note the rates of any postinduction respiratory events. It would have been beneficial to include this analysis in order to discern whether the difference in respiratory events was limited to the induction period.